Cabinet with remote integration

ABSTRACT

Devices, systems, and methods are described for remotely managing items that are configured to be stored in at least one dispensing device. This includes receiving user identification information at a host computer system from an electronic device that is remotely located from the dispensing device. This also includes transmitting from the host computer system to the electronic device a disposition of at least one item, wherein the at least one item is associated with a patient. Further, this includes receiving, at the host computer system from the remote electronic device, information about the item originating from the dispensing device, wherein the information includes a further disposition of the item.

CROSS-REFERENCES TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.12/502,172 filed on Jul. 13, 2009, entitled “CABINET WITH REMOTEINTEGRATION,” which is a continuation in part of U.S. patent applicationSer. No. 12/140,964 filed on Jun. 17, 2008, entitled “PATIENT-SPECIFICBIN SYSTEMS, METHODS, AND DEVICES.” This application hereby incorporatesby reference herein the content of the aforementioned applications intheir entirety and for all purposes.

BACKGROUND OF THE INVENTION

The present invention relates in general to the remote managing,documenting distribution, and monitoring of items from a storage system.In particular, the present invention relates to remote-managing,distribution, documenting of distribution, and monitoring of items usedin a health-care environment. In many cases, this involves thedistribution, issuing, return, and wasting of medications,pharmaceuticals, and medical supplies to and from dispensing units.

Many industries require items to be available for use at specificlocations. For example, in hospitals, practitioners may find itconvenient to place medications and medical supply items near wherepatients are being treated. A nursing station is one such location, asnurses may find it more efficient to have certain medications andsupplies readily available. The items being dispensed may need to bedocumented. This documentation requirement may be due to law,regulation, or likelihood of theft. For these and other reasons, thedispensing device may be required to be locked. Depending on the type ofitems dispensed, the environment where the items are used, and othervariables, a variety of dispensing units and cabinets have beenemployed.

Typically, documentation or information may be entered directly to adispensing device before medications, supplies, or other items may beremoved by an authorized user. The entering of such information may betime consuming, inconvenient, and may cause a backlog of users waitingto access the dispensing device. It would therefore be beneficial tocreate systems, methods or devices that address these issues and thatminimize the amount of direct interaction with the dispensing units.

BRIEF SUMMARY OF THE INVENTION

The invention provides various systems, methods, and devices thatfacilitate the storage and distribution of medications and supply items,including an accounting for how such items are used. In many cases,efficiencies are increased by providing the caregiver with variousaccess points so that the required documentation may be entered atconvenient locations and times, rather than directly at dispensing unitsor devices employed to hold such items. In some cases, the dispensingdevices (e.g., cabinets, drawers, and shelves) may include a number ofbins for storing the items, and some of the bins may be allocated aspatient-specific bins available to be assigned for patient-specificstorage and dispensing functions. Rather than requiring the healthcareworker to directly interface with such dispensing devices each time thatan item needs to be removed, returned, wasted or otherwise accountedfor, the caregiver may remotely provide appropriate information atvarious access points. These access points may include laptops,terminals, bedside devices, mobile devices, or a device which candisplay a webpage. The access point may be accessible via a privatenetwork, such as a secured hospital network, or a public network, suchas the Internet.

For example, in some embodiments of the invention, a method is providedfor remotely managing items that are configured to be stored in at leastone dispensing device. User identification information, such as logininformation, may be sent from an electronic device that is remotelylocated from a dispensing device. A user at the remote device mayrequest a disposition of at least one item originating from one ofdispensing devices. Information regarding the item may be received atthe electronic device remotely located from the dispensing device. Thisinformation or disposition may relate to a wasting of the item, thereturn of the item to a dispensing device, or to some other dispositionof the item. The user may transmit information regarding the previouslyremoved item from the remote electronic device. In this way, thecaregiver may remotely provide a request to return an item at a latertime or to waste an item remotely, and remotely provide follow upinformation on the request.

The items a caregiver might be managing remotely may be controlledmedical substances, including pharmaceuticals, and medical supplies.Further, the caregiver may not be returning or wasting entire items.Rather, a portion of the item may have been used, with a furtherdisposition being necessary for only a remaining portion of the item.

In some embodiments of the invention, a system for dispensing items isprovided. The system may include one or more dispensing devices, such ascabinets. These dispensing devices may be configured to hold one or moreitems. The dispensing device may be able to accept user input via aprocessor. The system may also include a host system. This host systemis configured to communicate with the dispensing device. Useridentification information may be input to an electronic device. Theelectronic device may be remotely located from the dispensing device. Auser request, such as by a caregiver, for a disposition of an itemoriginating from the dispensing device may be made at the remoteelectronic device. In this way, the caregiver may remotely provide arequest to return or waste an item from a remote location. Informationregarding the further disposition of the item may be sent to the remoteelectronic device. The caregiver or user may then document and transmitfurther information about the disposition of the item from the remoteelectronic device.

In another exemplary embodiment of the invention, a method of monitoringthe distribution of items is present. The method includes a subset ofdata contained in a first patient record being retrieved from anadministration records system. A second patient record that containsfields for information regarding medication of a patient may be createdon a host system. At least some of the data contained in the firstpatient record may be incorporated into the second patient record. Someor all of the second patient record may be transmitted to an electronicdevice. The electronic device may be remotely located from a dispensingdevice. This second patient record may be modified at the remoteelectronic device. Such a modification may include a disposition of acontrolled medical substance, medical supply, or other item stored inthe dispensing device. In this way, a caregiver or other user may besaved from having to create a patient record for a patient that has anexisting patient record in an administration records system. Thecaregiver may then be able to document information relating to thereturning or wasting of the controlled medical substances, medications,or items related to the patient.

BRIEF DESCRIPTION OF THE DRAWINGS

A further understanding of the nature and advantages of the presentinvention may be realized by reference to the following drawings. In theappended figures, similar components or features may have the samereference label. Further, various components of the same type may bedistinguished by following the reference label by a second label thatdistinguishes among the similar components. If only the first referencelabel is used in the specification, the description is applicable to anyone of the similar components having the same first reference labelirrespective of the second reference label.

FIG. 1 illustrates an embodiment of a dispensing system with remoteintegration.

FIG. 2 illustrates another embodiment of a dispensing system with remoteintegration.

FIG. 3 illustrates an embodiment of a dispensing device.

FIG. 4 illustrates another embodiment of a dispensing device.

FIG. 4B illustrates another embodiment of a dispensing device.

FIG. 5 illustrates an embodiment of a login window.

FIG. 6 illustrates an embodiment of a menu window.

FIG. 7 illustrates an embodiment of a wastes and returns window.

FIG. 8 illustrates an embodiment of a witness window.

FIG. 9 illustrates an embodiment of a reason for waste window.

FIG. 10 illustrates an embodiment of a waste dispensing alert window.

FIG. 11 illustrates another embodiment of a waste dispensing alertwindow with a question regarding the item.

FIG. 12 illustrates an embodiment of a return window.

FIG. 12 b illustrates an embodiment of a pending returns window.

FIG. 13 illustrates an embodiment of a method of receiving patientrecord information.

FIG. 14 illustrates an embodiment of a method of wasting an item or aportion of an item.

FIG. 15 illustrates an embodiment of a method of returning an item or aportion of an item to a dispensing device.

DETAILED DESCRIPTION OF THE INVENTION

The invention provides various ways to dispense items and account forsuch items in an efficient manner. The invention may be used inconnection with a wide variety of dispensing devices employed to storeand dispense such items. Such dispensing devices may be constructed froma cabinet having various storage locations for storing the items.Dispensing devices may include cabinets, drawers, bins, shelves, or anycombination thereof. These dispensing devices may be freely accessibleor may be secured with various locks. Such is often the case whenstoring pharmaceuticals, controlled medical supplies, and othercontrolled items.

It may be necessary for the location and disposition of items to bemonitored, recorded, or documented. Such requirements may be necessaryto comply with the law, a hospital's policies, or for safety. While thelocation of these items may need to be constantly monitored, users, suchas nurses, doctors, or other medical professionals, may require frequentaccess to the items. For example, a user may need to remove an item fromthe dispensing device several times per day, such as to administer theitem to a patient following each meal. In some cases, only a portion ofan item may be administered to a patient. The administered amount mayneed to be documented, and the remaining portion of the item returned toa dispensing device. As another example, a user may initially remove anitem from a dispensing device then later determine the item should nothave been removed. In such cases, the user may need to return the entireitem to a dispensing device and document its return.

Accordingly, a variety of situations arise where items may need to beremoved from a dispensing device, discarded, destroyed, or returned to adispensing device. The person responsible for the item may be requiredto provide information to document the action required. The requiredinformation may involve: a reason for the issuing/removing, returning,discarding, or destroying the item, the identity of a witness to thereturning, discarding, or destroying of the item, patient information,time and date information, or any other related information. While suchinformation may be documented via a dispensing device, this may lead toproblems. For example, if a user is documenting her actions involvingstored items at a dispensing device, it may delay another user fromdocumenting her actions. Also, it may prevent another user fromissuing/removing an item from the dispensing device. In someembodiments, the invention provides for documenting and informationgathering at a device remote from the dispensing device. The dispensingdevice or a host computer system may communicate with the remote device,such as a computer terminal, handheld, electronic device, laptopcomputer, or a similar device. This may allow a user to provide some orall of the necessary information for documentation of the use of an itemaway from the dispensing device.

Remote documenting and information gathering may decrease the amount ofinformation a user must supply at the dispensing device, or eliminatethe need to physically visit a dispensing device. A common procedureinvolving controlled medical substances may be referred to as “wasting.”“Wasting” may mean the physical destruction of an item or a portion ofan item, or the discarding of an item or a portion of an item.Documenting the discarding or physical destruction of an item or aportion of an item remote from a dispensing device may allow a user tocompletely avoid visiting a dispensing device. This may present asignificant savings in time, effort, and efficiency. These benefits maybe especially apparent if the dispensing device is located on adifferent floor and/or in a different building.

While a user or agent of the user may need to physically visit adispensing device to return an item or a portion of an item, documentingthe return of the item remotely may still present significant timesavings for the user and other users. Documenting a return remotely maybe more comfortable, such as at a desk or home as opposed to at adispensing device, and more time-efficient, especially if other usersare waiting to access the dispensing device. Documenting a returnremotely may allow a user to provide the majority of necessaryinformation remotely with minimal information provided at the dispensingdevice, such as only the user's username and password.

Further, documenting a return to a dispensing device or the wasting ofan item or a portion of an item may not require a bedside administrationsystem. A bedside administration system may require that documentationbe performed before, during, or after a medication is administered to apatient or before, during, or after a supply is used. For example, whena medication is given to a patient, a barcode associated with themedication and a barcode associated with the patient may need to bescanned. Similar systems include electronic administration documentationor electronic medication administrations records. Such systems are usedto document the dose, the date, the time, and the patient when amedicine is administered. As long as a remote device, such as acomputer, can occasionally remotely communicate with the server or otherdevice serving as a host for the dispensing system, no furtherdependency on any other system may be present. A remote device thatinteracts with a remote integration system may allow for wasting to bedocumented at a location where the item or portion of then item isdesired to be wasted.

Despite not requiring a bedside administration system, a dispensingsystem with remote integration may have the capability interact withvarious bedside administration systems, produced by variousmanufacturers. For example, a dispensing system with remote integrationmay interact with SAFETYMED sold by OMNICELL, among other bedsideadministration systems offered by other manufacturers. The incorporationof a bedside administration system may create an additional layer ofaccountability for the location and use of supplies and medicines.Further, the integration of such a bedside administration system maysimplify and expedite the entry of information into the remoteintegration system. By way of example only, if a nurse has removed 500mg of Drug A from a dispensing cabinet, the use of a bedsideadministration system for the administering of 300 mg of Drug A to thepatient would result in the dispensing system with remote integrationbeing notified that only 200 mg of Drug A is left unaccounted for. The300 mg of Drug A would be automatically denoted as administered to thepatient in the remote integration system. In addition to automaticallydenoting the amount administered to a patient, other values may beautomatically entered into the remote integration system. Such valuesmay include: if and how much waste is outstanding, if and how much of areturn is outstanding, and the amount that must be returned or wasted.

Referring to FIG. 1, an example of a dispensing system with remoteintegration 100 is illustrated. Such a system may be used for storing,managing, and distributing items. These items may include medications,pharmaceuticals, medical supplies, controlled medical substances,controlled medical supplies (such as syringes), and the like(hereinafter collectively referred to as “items”). Alternatively, theseitems may be any objects that are desired to be stored, managed, ordistributed in a controlled manner. The use of these items may need tobe documented and/or witnessed. The system 100 includes a dispensingdevice 120-a (e.g. cabinet with a number of storage locations, such asshelves, drawers, or bins) for dispensing items. The system alsoincludes a server computer system 105, which is communicativelyconnected with data stores 110, a central dispensing unit 115, and thedispensing device 120-a. In some embodiments, one or more of thesecomponents may be removed or substituted with other devices.

A dispensing device may be any device for dispensing items, such as acabinet for storing medications for patients in a healthcare facility.In other embodiments, aspects of the system may be used in differentsettings to dispense a range of varying objects. A dispensing device maybe stationary, such as a nursing cabinet serving a particular area of ahospital, or may be mobile, such as a cart with drawers. Examples ofseveral successful dispensing cabinets are described in U.S. Pat. Nos.6,760,643; 6,609,047; 6,272,394; 6,385,505; 5,805,455; 5,805,456;5,745,366; 5,905,653; 5,927,540; 6,039,467; 6,151,536; 5,377,864; and5,190,185, the complete disclosures of which are herein incorporated byreference. The dispensing device 120-a may be in wired or wirelesscommunication with the central server computer system 105.

The dispensing device 120-a may be located at a nursing station servinga number of rooms, in an operating room, in an emergency room, in anintensive care unit, or in a number of other locations within or outsidethe medical field, as evident to those skilled in the art. Thedispensing device may be profiled by patient, with certain patientshaving a certain area or areas within the dispensing device assigned tothem. In some embodiments, the dispensing device is stocked withspecific items or medications. In such embodiments, a request for aparticular item or medication may be issued from the dispensing deviceno matter who the patient is. The dispensing device 120-a may be mobile.The dispensing device 120-a may include a computer and consoleconfigured to manage the storage and distribution, of items at thedispensing device, and networked to communicate continuously oroccasionally with the server computer system 105. There may be differentlevels of security for particular sections or bins within the dispensingdevice 120-a. Sections of the dispensing device 120-a may be lockedwhile other sections are not locked.

Items to be stocked at the dispensing device 120-a may be stored at acentral dispensing unit 115. The central dispensing unit 115 may be acabinet, dispensing device, warehouse, pharmacy, or any other placewhere items to stock a dispensing device 120-a may be stored. Thecentral dispensing unit 115 may be in communication with the centralserver computer system 105. Such communication allows for the trackingof the stocking of the dispensing unit 120-a.

The dispensing device 120-a may be in communication with a centralserver computer system 105. Data related to the patients, contents andaccess to the dispensing device may be stored at the central servercomputer. In some embodiments, the data may be stored at the dispensingdevice 120-a. The central server computer system 105 may communicatewith a number of data stores 110. The data stores 110 may be local tothe central server computer system 105 or may be located remotely. Thedata stores 110 may store information on patients, contents of thedispensing devices, users who have access to the dispensing devices, orany other pertinent information to the operation of the system 100. Insome embodiments, several dispensing devices 120 may be present, witheach connected to the central server computer system 105. In someembodiments, the functionality of a central server computer system 105,and data stores 110 may be integrated with the dispensing device 120-aor dispensing devices 120.

Referring to FIG. 2, a simplified block diagram of an embodiment of adispensing system with remote integration 200 is illustrated. The system200 of FIG. 2 may illustrate an alternative embodiment of the system 100described with reference to FIG. 1. The system 200 may include some ofthe same components as the system 100 of FIG. 1, such as the centralserver computer system 105.

The system 200 of FIG. 2 includes a central server computer system 105,which is communicatively connected to each of the dispensing devices220. The central server computer system 105 of FIG. 2 may perform any ofthe functions previously described with reference to the central servercomputer system 105 of FIG. 1. The central server computer system 105may be communicatively connected through a network 210 to a remotewireless terminal 250, a remote wired terminal 240, and/or a userterminal 230. The central server computer system 105 may be connected toany number of terminals. These terminals may be local or remote from thecentral server computer system 105 and the dispensing devices.

The remote wireless terminal 250 may be a computer, a workstation, alaptop, a mobile device, a hand-held electronic device, or any otherdevice capable of wirelessly communicating with the central servercomputer system 105. The remote wireless terminal 250 may be any devicecapable of displaying a webpage. The remote wireless terminal 250 mayinterface with a network 210, through a wireless router. The remotewired terminal 240 may also be a workstation, a laptop, a kiosk or anyother device capable of communicating with the central server computersystem 105. The remote wired terminal 240 may be any device capable ofdisplaying a web page. The remote wired terminal 240 may have a physicalconnection to the network 210, such as via a local area network cable.The ability of the remote wired terminal 240 and the remote wirelessterminal 250 to interact with the central server computer system 105 maybe similar, or may include different functionality. The remote wirelessterminal 250 and the remote wired terminal 240 may be physicallyseparated from the dispensing devices 220. Alternatively, the remotewireless terminal 250 and the remote wired terminal 240 may be locatedadjacent to a dispensing device 220.

The user terminal 230 may be remote from the dispensing devices 220 ormay be local to the dispensing devices 220. In some embodiments, a userterminal 230 may be a computer integrated with the dispensing devices220. The user terminal 230 may be any device capable of communicatingwith the network 210, or the central server computer system 105, anddisplaying a webpage.

Functionality available at the dispensing devices 220 may be availableat the terminals 230, 240, and 250. This functionality may include theability to document the use of items. For example, if an authorized userwishes to remove an item from a dispensing device 220, he may berequired to identify himself, the patient, the name of the item, theamount of the item, the prescribing doctor, the time administered to thepatient, and/or any other information relevant to the removal(alternatively referred to as issuance) of the item. The informationrequired to be entered by the user or available to the user may varydepending on the industry, the law governing the location of thedispensing device, or the regulations of the entity operating thedispensing device. The necessary information may be input at thedispensing devices 220. The terminals 230, 240, and 250 may allow atleast some of this information to be input remotely from the dispensingcabinets.

Four typical operations involving a dispensing device 220 are issuanceof an item, issue of an item, return of at least some of an item, andwasting at least some of an item stored at or removed from a dispensingdevice 220 or other depository. A user may request an item be issuedfrom a dispensing device 220. When a user requests an item be issuedfrom a dispensing device, the user may need to acquire authorizationfrom a doctor, practitioner, or other authorized user. Thisauthorization may happen through the central server computer system 105,orally, or in a written form. In some embodiments, the user may berequired to obtain authorization from a pharmacy before issuance of anitem from a dispensing device 220.

In some embodiments, the user will require authorization from a doctor,practitioner, or other authorized user and a pharmacy or other agencymaintaining control over the items. In an emergency situation, the user,depending on her authorization to the dispensing device 220 and thecentral server computer system 105, may be able to override anyauthorization or documentation requirements. Such an override may allowitems to be dispensed from the dispensing device 220 withoutauthorization. In some embodiments, the user may be required to enterthe necessary information after the emergency situation has subsided.For example, at a healthcare facility, a nurse may determine a certainprescription medicine is immediately necessary to save a patient's life,with no time available for approval from a pharmacy or doctor. The nursemay be able to override the authorization requirements of the dispensingdevice 220 and access the item necessary. The nurse may then enterpertinent information at the dispensing device, a wireless terminal, awired terminal, or user terminal at a later time.

A request for issuing of an item may be made from any terminal 230, 240,250 that can communicate with the central server computer system 105.This may be in place of, independent of, or integrated with any bedsideadministration product as previously described, and allow a user toremotely request an item prior to the user physically going to adispensing device. Depending on the user's access level, the itemrequested, the hospital's policy, and local law, varying requirementsmay be set as to the reporting requirements, the user must provide forissuing of the item from the dispensing device 220.

Further, while the removal or issuing of items from a dispensing deviceis often discussed as from a dispensing device, items may also be issuedfrom other locations. For example, an item may be issued to a user by apharmacy, a central dispensing location, or some other depository. Theitem being initially issued by a depository other than a dispensingdevice may not impact the use of a dispensing system with remoteintegration. For example, if an item is directly issued from a pharmacyto a user, the item may still be documented and wasted using adispensing system with remote integration, or if a return is necessary,the item may be documented and returned to a dispensing device or tosome other depository. In some embodiments involving returns, thelocation or device the item is initially issued from has no bearing onthe location or device the item is returned to.

FIG. 3 illustrates an embodiment of a dispensing device 310. The patientdispensing device in this embodiment is a cabinet 310, which may beconstructed from a cabinet frame 312 with various transparent panels314. Cabinet 310 further includes a pair of doors 316 and 318 thatenclose a series of shelves 320 within the cabinet 310. These enclosedareas may be temperature-controlled or refrigerated in variousembodiments. Shelves 320 may be divided into various storage locationsusing adjustable dividers 322. Further, associated with each storagelocation may be an item button 324 that may be pressed to record theissuance or removal of items from or placement of items into eachstorage location. A light 326 may also be positioned adjacent each itembutton to guide the user to a specific storage location. Further, alabel 328 may be associated with each storage location and may includeinformation on the items stored in a particular storage location.Optionally, doors 316 and 318 may be locked and only opened whenappropriate identification information has been entered into a computer330 or at a remote terminal, device, or computer. Hence, to remove anitem from one of the shelves 320, a user may enter appropriateidentification information directly into computer 330, with associatedinformation possibly entered via a remote device or computer. In otherembodiments, the storage locations or zones could vary in size,configuration, and security. The locations may be allocated forassignment to patients as patient specific bins (PSBs), and thelocations available may be adjusted depending on current and projecteduse levels and occupancy factors. PSB allocation and patient binassignment may be made by the computer 330, or received from a remotelocation (e.g., central server computer system 105 of FIG. 1A). Thelocations may also be allocated by item size, type, classification,security level, need for refrigeration, alphabetically, or any otherorganization scheme.

To facilitate the entry of information, the computer 330 may include atraditional keyboard 332 and a key pad 333 containing numeric keys. Atouch pad 333 a may be disposed above key pad 333 and used to control apointer on a display screen 334. Disposed below key pad 333 are keys tocontrol the contrast of display screen 334 and to control the sound thatmay be emitted from a speaker 333 b. Disposed below keyboard 332 is areceipt port 333 c through which printed receipts or labels may pass.The panel containing keyboard 332 may be rotated downward to gain accessto the receipt printer. The illustrated computer configuration is forpurposes of example only; in other embodiments, any subset of thefeatures may be employed, and particular implementations and inputdevices may vary.

One use of the various input devices on the computer 330 is to permitthe user to select one or more items that are to be removed. Ifinformation is entered by the user at a remote terminal, device, orcomputer, the amount of information that must be entered at the computer330 may be reduced. A list of items generated by the computer 330 orreceived from the central server computer system 105, may be displayedon the display screen 334. Further, display screen 334 may be a touchscreen display that permits various items to be selected simply bytouching them on a display screen 334. Computer 330 may be coupled toany type of computer network to permit various information to besupplied to computer 330 (e.g., by the central server computer system105 of FIG. 1A). For example, stock or restock lists may be transmittedfrom the central server computer system 105, as may lists for cleaningor other removal of items.

When the appropriate items have been selected, doors 316 and 318 may beunlocked (in cases where doors 316 and 318 are already locked) and theappropriate lights 326 may be lighted to guide the user to the itemsselected. Upon issuance or removal of the items, the user may press itembuttons 324 a number of times corresponding to the number of itemsremoved. A similar process may be used for restocking items into thestorage locations.

A cabinet 310 may further include a pharmacy section 336 with variousdrawers 338 for holding pharmaceutical items or other types of itemsthat need additional security. When appropriate information has beenentered into computer 330, the appropriate drawers 338 may be unlockedand lights 340 on the drawers lighted to guide the user to theappropriate doors. Drawers 338 may conveniently include various bins,shelves, or storage locations that may be assigned to different items,categories of items, or patients, which may optionally have bookablelids to provide additional security to the items. The lids correspondingto bins that have the selected items may be unlocked and users may beguided to the unlocked bins using lights in a manner similar to thatdescribed with shelves 320.

In one embodiment, pharmacy section 336 further includes a dispensingunit area 342. Briefly, dispensing unit area 342 includes a dispensingunit frame that is insertable into cabinet frame 312 of cabinet 310.Coupled to the dispensing unit frame is a door 346 that may be opened toprovide access to dispenser frame. Although dispensing mechanisms maytypically be associated with items for use by a number of patients,particular bins associated with dispensing mechanisms may be assigned topatients in some embodiments. Below dispenser frame is a dispense drawer352 that receives items that fall from dispensing mechanisms after suchitems have been selected at computer 330. Bins within the dispensedrawer 352 may be assigned as PSBs on a temporary or more permanentbasis to specific patients. The dispense drawer 352 may include a light354 to guide the user to the dispense drawer 352 during dispensingoperations. A handle 356 may be provided on door 346 to meditate openingof door 346. The door 346 may include a light 357 to guide the user tothe door 346 during dispensing operations.

In some cases, dispensed items may need to be returned to cabinet 310.In some situations, various laws, regulations, or facility policiesprohibit dispensed items from being placed back into cabinet 310. Assuch, attached to (or otherwise integrated into) cabinet 310 may be areturn unit 358 having a slidable (or rotatable) door 360 that may beopened to permit the item to be placed into the return unit 358. Whenreturning the item, information regarding the return may be entered intocomputer 330. A light 362 on the return unit 358 may be lighted toindicate to the user that the item may be returned. The return unit 358is preferably configured so that once an item is placed into the unit,the item cannot be retrieved from the return unit 358 unless a restockuser or technician is authorized to gain access. For example, a restocktechnician may be required to enter appropriate information intocomputer 330 to cause the return unit 358 to unlock to allow access tothe items within.

Although one specific arrangement of cabinet 310 has been described, itwill be appreciated that any subset or combination of the abovecomponents may be used with a variety of dispensing cabinets. Forexample, a dispensing mechanism and unit may be placed within a cabinetthat is used solely for dispensing pharmaceuticals and may only includedrawers similar to drawers 338. As another alternative, such mechanismsand units may be placed in a cabinet that only includes shelves that aresimilar to shelves 320. Further, such mechanisms and units may be usedin cabinets having multiple shelves and/or drawers that are placedside-by-side in a vertical arrangement. Also, a dispensing cabinet mayinclude multiple dispensing unit areas 342. These may be sized to thesame size, or may be different sizes. Still further, in some cases suchdispensing cabinets may include other types of shelves, racks, drawers,and the like to facilitate the storage of items.

There are a number of different configurations of other types ofdispensing devices 120 and 220 of FIGS. 1 and 2, respectively. FIG. 4illustrates yet another example of such a device. The illustrateddispensing device 410 may include one or all of the functions of thepatient dispensing devices 120 described with reference to the system100 of FIG. 1. Thus, the device 410 may be in wired or wirelesscommunication with the central server computer system 105.

The dispensing device 410 includes a cabinet 412 having a number ofretractable drawers 414. Although shown with 12 drawers, the number ofdrawers may be varied. The cabinet 412 may rest upon wheels 416, whichallow the dispensing device 410 to be wheeled throughout the healthcarefacility. The cabinet may be battery powered and configured tocommunicate wirelessly (e.g., to allow communication while in transit).The cabinet 412 may be fashioned with various dimensions.

The dispensing device 410 further includes an integrated computer(hidden within cabinet 412) and a keyboard 418 for entering variousinformation into the computer. For example, keyboard 418 may be employedto enter patient identification information, user identificationinformation requests for item stocking, issuing, and removal, and thelike into the computer. Optionally, the dispensing device 410 mayfurther include a second entry device 420 which is connected to thecomputer and includes a screen 422 which allows the user to scrollthrough various lists of information in order to select a highlighteditem. For example, a caregiver may scroll through a list of patientnames or item names in order to select a certain patient or to enter anitem removal, issuance, or stoking request. In one embodiment, thescreen may be a color touch screen. The touch screen may be configuredto allow a user to interact with the dispensing cabinet, with or withouthaving to use the keyboard, mouse, or other traditional methods, as thetouch screen functionality allows a user to touch their selectiondirectly. The touch screen may be a color touch screen, and colordistinctions may inform and guide the user (e.g., alerts or warnings inyellow, item unavailability in grey, next steps in green).

A printer 424 may be provided on cabinet 412 to print various reports orlabels generated by the computer. In other embodiments, some of thecomputing functionality for a device 410 (e.g., display, input device,reader, etc.) may be detachable or otherwise separate from the device410, and may communicate wirelessly with the device 410 or centralserver computer system 105.

The cabinet 412 may further include a magnetic, bar code, RFID, datacollector or other reader 425 which is connected (directly orwirelessly) to the computer. Such a reader 425 may be employed on any ofthe dispensing devices 120 described herein. It may be configured tomanually or automatically scan for types and associated quantities orlevels then provide the data to the cabinet 512 or to the centralcomputer system 105. The reader 425 may be provided to allow a user, apatient, or particular medications or other supplies to be identified.For example, an identifier (e.g., magnetic, bar code, RFID, or otheridentifier) may be read from a medication container when an item isstocked, restocked, or removed. The identifier (and amount) may then betransmitted to the central server computer system 105 or otherwisestored, for purposes of tracking inventory. Similarly, an identifier(e.g., magnetic, bar code, RFID, or other identifier from an access cardor other instrument) may be read from the user of the device or patientassociated with the device. The reader 425 may also be employed to readan identification device associated with the drawers, as well.

To retrieve or remove items of a particular patient, a user (e.g., anurse user or other caregiver, patient, automated system, etc.) mayenter user identification (e.g., a password, PIN, smart card, RFID,combination thereof, etc.) using keyboard 418, reader 425, or entrydevice 420. The user (or the computer 330) may then identify thepatient. The patient identification may be entered by the user usingkeyboard 418, reader 425, or entry device 420. The user may select thedesired medication or other supplies, or the computer (or a centralserver computer system 105) may direct the user (via lights or alisting, for example). The user may also enter the number of items ofthe selected type that are to be removed or retrieved for the patient.The user may then retract the proper drawer and will be led to thecorrect bin. There may be also a step of verifying the count of specificitems taken, by prompting the user to enter via keyboard 418 or entrydevice 420 the number of items of the specific type that were removed orsupplied and the number remaining. A record of this event may also bemaintained within the computer, or may be transmitted to the centralserver computer system 105 of FIG. 1, or elsewhere. A variety of otherremoval alternatives may be used, as well.

For stocking and restocking of items into dispensing device 410, thepharmacy or other central dispensing unit (e.g., central dispensing unit115 of FIG. 1) may prepare all items for a particular cart fill at aparticular PSB or set of PSBs together in a set of packages or othercontainer. The cart may also be stocked with various items notsegregated by patient. For example, certain locations in the cart mayalways contain certain items, or the items in the cart may be variedbased on present or future need. If the use of PSBs are desired, all ofthe medications for a given PSB may be gathered and consolidated at thepharmacy or other central dispensing unit before they are placed in thecart. The computer for the cabinet 410, or perhaps the central servercomputer system 105 of FIG. 1, may transmit the restock list to thepharmacy, or a list may be processed locally at the pharmacy. Theprocess of gathering and consolidating the supplies for a particular PSBmay therefore take place at the pharmacy or other central dispensingunit, instead of at the dispensing device 410. This may provide a moresecure environment, and result in less loss. It may also be moreefficient for a pharmacist instead of a nurse user to perform thesetasks.

To stock or restock a cart with items, the user may enter user, patient,and/or packages/container identification (e.g., a password, PIN, label,serial number, barcode, identification device, smart card, RFID, etc.)using keyboard 418, reader 425, or entry device 420. Thus, the entry ofuser, patient, or packages/container identification information (or anycombination thereof) may trigger the restocking process. The computerfor the cabinet 410 (perhaps controlled by the central server computersystem 105 of FIG. 1), may direct the user (e.g., via lights or screeninformation) to place the packages/container in the appropriatelocations or PSBs. The action may be logged, and perhaps transmitted tothe central server computer system 105.

In other embodiments, instead of having the pharmacy or other dispensingentity consolidate the restocking items, individual items may be placedon a shelf, drawer, storage location, or a PSB on an item-by-item basisat the dispensing device 410. For example, the pharmacy or other centraldispensing unit (e.g., central dispensing unit 115 of FIG. 1), orcentral server computer system 105 of FIG. 1, may be in frequent contactwith dispensing devices. Information may be exchanged with thedispensing devices, and in particular information on the currentquantity on hand for each item in each dispensing device. At regularintervals (e.g., every morning) a restock list may be generated for eachdispensing device, detailing the total quantity of each item to be takento the dispensing devices to bring the quantity in each drawer, storagelocation, shelve, or PSB up to a predetermined (or dynamicallycalculated) par level.

As another alternative, a pre-stocked liner for one or more bins,shelves, drawers, or storage locations may be prepared at the pharmacy,central dispensing unit, or elsewhere. The replacement liner may beconfigured to have the same arrangement of bins and items or a differentarrangement of bins and items. A variety of other restocking systems maybe used, as well. Although the retrieval and stocking are described withreference to the cabinet 410 of FIG. 4, these procedures may be appliedto other dispensing devices (e.g., the dispensing device 120 of FIG. 1),as well. The stocking or restocking may be performed when a patientfirst checks into a hospital, when there is a need for refills, or inmanaging a transfer, to name a few instances.

FIG. 4B illustrates an embodiment of a cart 427 that may be used inconjunction with a dispensing system with remote integration. Such acart 427 may be a RIO cart manufactured by OMNICELL, or it may be someother cart. The cart 427 of FIG. 4B is an example only, other carts withdifferent drawer or bin configurations may be used. The cart 427 mayhave a number of drawers 450 attached to a mast 460. These drawers 450may be controlled by a drawer controller. A drawer controller may lockor unlock each of the drawers 450. In some embodiments, no drawers 450are present. A battery 470 may be attached to the cart 427 to providepower. The mast 460 may be mounted to a rolling base 480. A rolling base480 may allow the cart to be wheeled between patients, rooms, anddispensing devices. The cart 427 may also include a work surface 440.Such a surface may be used for writing, preparation of medicines orsupplies, storage, or any other item or activity. The cart 427 may alsohave guiding lights (not pictured). Such guiding lights may indicate thelocation of items associated with a particular patient and/or mayindicate the location of a particular medicine or item. The guidinglights may be useful to visibly indicate to a user where an item islocated, or where a return should be placed.

The computer/monitor 430 may be a terminal capable of connecting to anetwork, either wirelessly or via a cable. Such a terminal may allow forcommunication with the central server computer system and interactionwith the dispensing system with remote integration. The computer/monitor430 may serve as any other terminal capable of interacting with adispensing system. The drawers 450 may be specific to particular drugsor particular patients. A user or nurse may have the ability, throughthe dispensing system with remote integration, to retrieve a list ofmedicines, supplies, or patients that he or she needs or will beresponsible for. This listing may be automatically generated by thedispensing system with remote integration. Alternatively, the user maycreate a listing of his other patients via the dispensing system withremote integration. The dispensing system with remote integration maythen produce a listing of medicines or supplies that the user must loadfrom a dispensing device, a pharmacy, or some other centralized locationto the cart 427. This may include an automatic assignment process wherea patient is assigned a particular drawer on the cart 427 by thedispensing system with remote integration. The generation of the listingfor stocking the cart 427 may automatically grant the user access to adispensing device. The stocking process may result in the user beinggranted access to some or all of the drawers 450 of the cart. Thedispensing system with remote integration may transmit to the cart 427 alisting of patients, medicines, or supplies that the cart 427 or theuser is associated with. The user may then be able to remove medicinesor supplies from the cart to administer to a patient, to waste, or toreturn to a dispensing cabinet or other storage center. The transmissionof instructions to the cart 427 may be done with alternativelyconfigured mobile carts. In some embodiments, a patient is assigned onedrawer on the cart 427. In other embodiments, multiple patients may beassigned to a drawer, or one patient may be assigned with multipledrawers.

At a terminal 230, 240 or 250 a user may be required to log in andprovide a password or other identifier to verify her identity. FIG. 5illustrates an embodiment of a login window 500 for a remote terminalsuch as 230, 240, or 250 of FIG. 2. A user may be required to enter auser identification 510. The identification number may be a number, ausername or screen-name. A user may also be required to enter a password520. In some embodiments, the user identification 510 and the password520 are replaced with a biometric device, such as a fingerprint scanneror a retina scanner, capable of identifying and verifying the identityof the user. Further, in some embodiments, a user identification 510 maybe input from a identification card with a magnetic stripe or from abarcode. Verification of the users identity then may be completed usinga password or a form of biometric identification.

The central computer server system 105 may communicate with, eitherdirectly or through the network 210, an administration records computerserver system 260. This allows information to either automatically ormanually be imported from administration records to the records used formanaging items related to patients. For example, information such as apatient's name, room number, a patient identification, allergies, andprescriptions may be copied from the administration records computerserver system 260 so that the information does not need to be manuallyentered to the central server computer system 105. In some embodiments,the administration records computer server system 260 is incorporatedwith the central server computer system 105.

Interaction of the central computer server system 105 and anadministration records computer server system 260, such as a bedsideadministration system, may provide additional benefits. As previouslydescribed, information stored at the administration records computerserver system 260 may be used by the dispensing system with remoteintegration 200 to determine how much waste is outstanding, if anyreturns are outstanding, the amount of an item that will need to bewasted, and the amount of an item that will need to be returned to thedispensing device. Such information may be used to automatically fillfields to the expected value of wastes and returns in windows requiringvalues from the user. Further, integration between the dispensing systemwith remote integration 200 and the administration records computerserver system 260 may allow for automated report generation of items ormedications that have been removed or issued from a dispensing device,but have not been administered, wasted, or returned to a dispensingdevice. Such a report may be on a patient by patient basis or may bebased on the responsible user or medical professional.

The user identification 510 and the password 520 may be verified at aterminal, a dispensing unit, or at the central server computer system.Proper identification of a user, such as providing a valid useridentification 510 and a password 520 may result in accessing beinggranted to an interface for interacting with the dispensing units.

Once access has been granted, the user may be presented with a menu,such as menu 600 of FIG. 6. The menu screen may contain various menuoptions, including: “Pending Cabinet Requests” 610, “Patient Profile”620, “My Patients Worksheet” 630, and “Wastes and Returns” 640. The“Pending Cabinet Requests” 610 option may display a screen to allow theuser to remotely generate a list of medications and their quantities toissue from a dispensing device. The “Patient Profile” 620 option mayallow a user to select, scan, or otherwise identify a patient the userwants to work with. This option may display information, includingmedication information, related to a specific patient, The “My Patients”worksheet 630 option may provide an overview of the user's patients.This overview may include information such as which items are due to beadministered to a patient.

The menu screen 600 may include a menu item such as “Wastes and Returns”640. In some embodiments, selecting “Wastes and Returns” 640 results ina display of a window of information and options relating to the wastingand return of items to a dispensing device. “Wasting” may mean thephysical destruction of the item or the portion of the item, or thediscarding of the item, or the portion of the item. Returning an itemrefers to an item than has been removed from a dispensing device orother depository, and is to be placed back in the same dispensing deviceor a different dispensing device. This may refer to the/entire item or aportion of the item.

FIG. 7 illustrates an embodiment of what a menu selection, such as“Waste and Returns” 640 of FIG. 6 may look like. Such a display may beprovided on a remote terminal, such as those described in relation toFIG. 4. Selecting “Waste and Returns” 640 of FIG. 6 may display thewaste and returns screen 700 of FIG. 7, or it may display a differentwaste and returns screen. Likewise, the waste and returns screen 700 maybe associated with the menu option waste and returns 640 of FIG. 6 ormay be associated with a different menu option on a different menu. Thewaste and return screen 700 may b divided into separate sectionsentitled in separate “Waste Medications” 710 and “Request CabinetReturns” 715 sections, such as with tabs. In some embodiments, thesesections are provided in one screen.

In the embodiment of FIG. 7, the waste medications 710 tab is active.Therefore, information pertinent to the wasting of items is displayed.In the embodiment shown, medications requiring wasting by the user areshown. In some embodiments, all patients, or all patients related to theuser may be displayed, regardless of whether wasting of a medication oritem related to the patient is required. In the waste and returns screen700, a patient's name 730 is displayed. Associated with this patient,are the following category headings: Medication 736, Issued 731, Doc'ed732, Intended 733, Undoc 734, Administered 735, and Waste 736. As thosewith skill in the art will recognize, the categories of data maintainedmay vary substantially based on the industry or field of use the itemsare being used in.

Entering wasting information via a waste medications screen from aremote device may allow a user to complete a wasting of an itemremotely. This may decrease the number of visits the user needs to maketo a dispensing unit. This may be especially useful if the dispensingunit is located a significant distance from where the user wishes tocomplete the wasting of the item. For example, in a hospital complex,the user may wish to complete the wasting in a different building thanthe location of the dispensing device. If a wasting requires a witness,this may save at least two people from traveling to the dispensingdevice. If all necessary information for a wasting is documented via aremote device, such as through an interface similar to the waste andreturns screen 700, a return visit to the dispensing device may havebeen eliminated.

Medication 736 may list the medication or item associated with thepatient 730 that is to be wasted. In this instance, the medication 736is morphine. The medication 736 heading may refer to the brand name orthe generic name of a medication. Alternate names may be displayed inparenthesis, or otherwise set off from the primary name of themedication.

The issued 731 heading may represent the amount and/or strength of anitem or medication issued to the patient 730. The quantity and unit ofissue may be displayed. A separate heading also titled “issued” may bepresent. This field may provide additional information related to issue,such as the date and time issued. The “Doc'ed” 732 header may list theamount of the medication 736 administered to the patient 730, minus theamount of canceled administrations. The “Intended” 733 heading may listthe amount of the medication 736 specified as the intended dose when themedication 736 was issued. This amount may clear when an amount of themedication 736 is wasted. The “Undoc” 734 heading may list the amountsof the medication 736 that has not yet been documented.

The “Administered” 735 heading may allow a user to check (and uncheck) abox, and enter a numerical amount. In some embodiments, the user may begiven a list of values to select from. When the box is unchecked, theuser may be prevented from entered an amount administered. Afterentering an amount under the administered 735 heading, the user mayselect the “Document Medications” button 770 to save and update thedisplay with the new information. Selecting “Close” 775 may also saveand update the waste medications 710 and may return the user to a menu,such as menu screen 600 of FIG. 6.

The “Waste” 738 heading may allow a user to check (and uncheck) a box,and enter a numerical amount. In some embodiments, the user may be givena list of values to select from. If a witness is required for thewasting process, an icon 737 or other indication may alert the user thata witness is necessary for the wasting procedure. Selecting the icon 73may provide the user or witness with additional information, options, ora separate menu. When the box is unchecked, the user may be preventedfrom entered an amount to waste. After providing an amount under the“Waste” 738 heading, the user may select the “Document Medications”button 770 to save and update the display with the new information.Selecting “Close” 775 may also save and update the waste medications 710and may return the user to a menu, such as menu screen 600 of FIG. 6. Aseparate heading, entitled “Wasted” 750 may be displayed showing thetime, date, and amount 760 wasted.

For some medications, such as those that are non-multiuse medications,the amount to be wasted under the “Waste” heading 738 may beautomatically filled in. The user may or may not be able to edit thisdefault amount. Depending on the amount entered by the user, the otheramounts may be automatically adjusted such that the documented andwasted amounts sum to the total undocumented amount. In someembodiments, the user is allowed to specify any amount, with nodetermination of whether the amounts sum to the “Issued” or “Undoc'd”amounts.

In addition to the patients' names 725 and 730, additional informationmay be displayed. A patient's identification number 780 and/or roomnumber 785 may be displayed. If a patient has no active or future orderfor an item or medication displayed, an icon 727 or other alert maydisplay to alert the user that the patient has no active orders for themedication 736. If the user clicks on the icon 727, additionalinformation may be displayed. A “Select Patient” 720 heading with anassociated menu, may allow the user to filter the list of patients. Forexample, the user may be able to display all patients associated withthe user, a specific patient, or all patients that have pendingmedications or items to be wasted. Additionally, the user and site/areamay be displayed. A display of the name of the user or the usernamecurrently logged in and/or the site/area (such as “Emergency Room”) mayprevent a user from wasting or returning medication or items whilelogged to another user's account.

When a user selects an option related to waste, such, as “Waste” 738,“Document Medications” 770, or “Close” 775, a pop-up window, or otherdisplay may appear requiring witness information. If a witness icon 737is present, such a display may also appear.

FIG. 8 illustrates an embodiment of a witness window 800 that may appearwhen a user attempts to waste a medication or item that requires awitness. The display 890 may be associated with the waste and returnscreen 700 of FIG. 7, or it may be associated with some other waste orreturn system. A witness may be required to specify a useridentification 810 and a password 820. The user may not be permitted tocontinue with the wasting process until the witness' login informationhas been validated at the remote terminal, the dispensing device or thecentral server computer system. Alternatively, the witness may only haveto input her name. In some embodiments the patient's name 840 and amount860 and name 850 of an item to be wasted is displayed. In someembodiments, the witness pop-up window may list more than one item ormedicine requiring wasting. A check may be performed at the remoteterminal, the central server computer system, or the dispensing devicethat the witness is a different person than the user. This prevents auser from acting as both the person wasting the item or medicine and thewitness.

The ability to remotely enter and document a witness, such as in witnesswindow 800, may be especially useful for both wasting and return ofitems. A person may have time to be a witness, but only if it takes avery short amount of time. For example, a fellow nurse may be willing towitness the wasting of an item and quickly document the wasting remotelyat a remote device. However, that same nurse may not be willing towitness the wasting of an item if documenting the wasting requires atrip to a dispensing device that is inconveniently located.

The user may be prompted with a question regarding the reason for thewaste, such as in waste window 900 in FIG. 9. Such a window may displayfollowing, before, or instead of a witness window such as witness window800 of FIG. 8. For example, particular items may require a reason forwasting. The reason for waste window 900 may always display, or maydisplay only for those items or medicines which require a reason. Theuser may manually enter a reason 910 for the waste, or may selected areason 920 from a list.

The ability to answer questions remotely from a dispensing device may beespecially useful. Providing detailed, accurate answers at a dispensingdevice may be difficult if impatient users are waiting to use thedispensing device. Also, it may be easier to enter a detaileddescription from a remote device, such as a laptop or computer whilesitting at a desk, as opposed to standing at a dispensing unit.

Other alerts may be displayed during the wasting process. A wastedispensing alert window 1000 of FIG. 10 may be displayed after a witnesswindow, such as 800 of FIG. 8, a reason for waste window 900 of FIG. 9,or a waste and returns window 700 of FIG. 7. A waste dispensing alertwindow 1000 may appear for each item or medicine being wasted. The wastedispensing alert window 1000 may display the patient's name 1030 and theitem or medicine 1020 being wasted along with the amount. The user maybe prompted to confirm the waste 1010. The user may be presented anoption of whether to continue 1050 with the waste or cancel 1040.

FIG. 11 illustrates another waste dispensing alert 1100. This alert maybe displayed following a selection of a user that requires a wasting ofan item or medication. Some items or medications may require specificquestions to be answered regarding the item or medication. The alert maypose a question, with the user choosing among a selection of answerchoices 1110. There may be one or multiple questions for a particularitem or medication. Again, the user may have the option of continuing byresponding “ok” 1130 or canceling the wasting by responding “cancel”1120.

Following the user completing all steps relating to confirmation,witnesses, and reasoning, the wasting process will be complete. In someembodiments, the remote terminal or the dispensing device the data wasentered on by the user may be recorded. In some embodiments, the patientinformation displayed on the waste and returns window 700 of FIG. 7 willbe updated with the completed wasting information.

In addition to wasting, the user may determine to return an item to thedispensing unit. For example, if an item is still viable to be used foranother patient at a future time, the user may wish or be required tostore the item or medication in the same dispensing device she initiallyremoved it from, or in a different dispensing device. If the item wasinitially acquired from some other dispensing location, such as acentral pharmacy, they item may still be eligible to be returned to adispensing device or the dispensing location it was initially acquiredfrom. While the physical item will need to physically be placed in or ata dispensing unit, the information accompanying the return may beprovided to the center computer server system from a dispensing unit ora remote location.

Entering return information via a returns screen from a remote devicemay allow a user to at least partially complete the documentation of thereturn of an item or a portion of an item remotely. This may decreasethe amount of time the user must spend inputting information to adispensing unit. This may be especially useful if multiple users wish touse the dispensing unit or a large amount of information is required todocument the return. For example, at a hospital, the user may wish todocument the return from her desk, then drop off the item at a moreconvenient time. While the user may still need to physically visit thedispensing device, a minimum of information, such as only the user'susername and password may need to be provided at the dispensing device.

FIG. 12 illustrates an embodiment of a return window 1200, which may beused to remotely or locally stage a return transaction. The returnwindow 1200 may function as a tab 1210 of a “Waste and Return” window asillustrated in FIG. 7, or may function as a separate stand-alone window.The return window 1200 may provide information 1215 such as a patient'sname, a patient's identification number, and/or her room number. Thereturn window 1200 may provide a listing of all medication associatedwith a patient or only those medications that are required to bereturned. An item may only be displayed in the return window 1200 ifsufficient quantity of the item is available for return. For example,the item may only be eligible for return if it is at least the packagesize of the item. If a certain medicine is available in 100 mg packets,the item may appear in the return window 1200 only if 100 mg areeligible to be returned. If 50 mg of the 100 mg has been used, themedicine may not appear in the return window 1200.

The return window may provide several categories of informationregarding the patient and item or medicine to be returned, includingcategories entitled: Medication 1220, Issued 1230, Doc'ed 1240, Intended1250, Returned 1260, Wasted 1270, Undoc 1280 and Return Qty 1290. Eachof these categories of information may be information similar to thosecategories described in relation to the “Wastes and Returns” window ofFIG. 7. As those with skill in the art will understand, informationdisplayed may vary considerably depending on the industry or type ofitem being documented. The “Return Qty” 1290 may allow the user tospecify the amount of an item to be returned. The “Return Qty” 1290 maybe listed by package quantity. The “Return Qty” 1290 may be a plus/minuscontrol, forcing the user to enter a whole package number of items to bereturned. A witness may be required to execute a valid return. An icon1285 may be used to identify that a witness is necessary for the return.The requirement of a witness may result in windows and prompts similarto those presented in FIG. 8. In some embodiments, because a return mustphysically be conducted at a dispensing unit, the witness may notprovide identification information or confirmation information until thewitness is present at the dispensing device. Despite the need for thewitness to be physically present at the dispensing device, a significanttime savings for the nurse may still occur. For example, if the nurse isaware ahead of time that a witness is required, he may be saved fromtraveling to the dispensing device, being prompted for witnessinformation, and then setting out to search for a viable witness.Rather, the nurse may find a viable witness on his initial trip to thedispensing device.

An icon 217 or other alert may be displayed if the patient 1215 has noactive or future orders for a medication 1220. After entering a returnquantity, the user may create the return request 1291 or cancel thereturn request by selecting close 1292. The list of items to be returnedmay be blocked from editing if information required to proceed has notbeen provided. The list may also be uneditable if the network connectionof the remote device or dispensing device is not functioning properly.

After a request is created the return may be displayed or marked as“incomplete” or “pending” until the return is received by a dispensingdevice. Pending Returns window 1200 b in FIG. 12 b illustrates apossible embodiment of a pending returns window accessible by the user.A window 1200 b may be accessible as a tab 1210 b through another windowor it may be a stand-alone window. The user may be able to adjust thequantity to be returned 1230 b, or cancel a return 1240 b. A dispensingdevice or location 1220 b may be listed as where the item is due to bereturned. After the item is received at the dispensing device, thereturn may be marked “completed,” removed from the “Pending Returns”window 1210 b, or otherwise denoted as returned to a dispensing device.

FIG. 13 illustrates an embodiment of a method 1300 of receiving patientrecord information. Such a method may be used to import information to acentral server computer system from an administration records computerserver system, such as illustrated in FIG. 2. The central computerserver system may receive a user name 1301 and a password 1303 from aremote terminal. The central computer server system may then confirm1305 the user name and password. The confirmation 1305 may includedetermining whether the user has access to the central computer serversystem, to dispensing devices, and/or to specific dispensing devices inthe user's vicinity. Once the user name and identity have been confirmed1305, menu options may be transmitted to the terminal. The user mayselect and transmit to the central computer server system an updaterequest 1309 for new or modified patient records. In some embodiments,the user may not need to request an update, with the new patients beingautomatically imported to the central computer server system.

Upon receipt of the update request 1309, the central computer serversystem may request records from the administration records computerserver system. In some embodiments, the administration records computerserver system may automatically send the central computer server systemnew or updated patient records whenever one becomes available or after apredefined period of time, such as every ten minutes. In someembodiments, the central computer server system is incorporated with theadministration records computer server system, and no updates arenecessary. Following the request for records 1310, the central computerserver system receives the new or modified record or records 1320. Therecord may be imported 1330 as a whole, or selected parts of the recordmay be imported. For example, the patient's name, room number, andpatient identification number may be imported, but his symptoms and eyecolor may not be. In some embodiments, all of the patient's informationis imported.

Following the information being imported or incorporated into the recordat the central computer server system, the new record may be transmitted1340 to the remote device. The user may then view the record and modifyit. Finally, the central computer server system may receive 1350additional or modified information about the record from the remotedevice. Such information may relate to items or medication beingadministered to the patient. Portions of this method may repeat toupdate or modify the record on the central computer server system as newinformation becomes available to the user or the administration recordscomputer server system.

FIG. 14 illustrates an embodiment of a method 1400 of wasting a portionof an item removed from a dispensing device. First, the user may berequired to log in. This may require transmitting from a remote deviceto the central computer server system the user name 1405 and/or password1410 of the user. Alternatively or additionally, biometric informationmay be used to confirm the identity of the user. Once the user name andpassword are received by the central computer server system, the user'spermission to access the central computer server system, dispensingdevices, or dispensing devices in the user's vicinity is verified. Onceit is confirmed the user has the right to access the central computerserver system, menu options are transmitted 1413 to the remote terminal.Alternatively, the user's identity may be verified at the remoteterminal with no transmissions to the central computer server system.

The central computer server system may then receive 1414 a selectionfrom a menu. The selection made by the user at the remote terminal mayinclude specifying that an item is to be wasted. The central computerserver system may transmit patient information 1435 to the remotedevice. This patient information may include a listing of items removedfrom a dispensing device for use with the patient, the dosing of theitem, the patient's name, and the patient's room number. The patientinformation may be include all patients associated with the user or maybe only patients associated with an item that requires wasting. Thecentral computer server system may transmit 1420 a listing of items thatare required to be wasted.

The central computer server system may then receive 1425 informationrelated to wasting. This may include a quantity of an item to be wasted.In response to receiving this information on wasting, the centralcomputer server system may transmit a witness requirement 1430. Thiswitness requirement may be similar to witness window 800 of FIG. 8, ormay be some different witness information. In response, the centralcomputer server system may receive information, including the witness'user name 1435 and password 1440 from a witness at the remote terminal.The central computer server system 1445 may then confirm that thewitness is a different person than the user.

In some embodiments, the central computer server system may transmit1450 a request for a reason for wasting the item may be requested fromthe user or witness. The request for a reason for wasting the item maybe in the form of a window, such as window 900 in FIG. 9, or in someother form. The central computer server system may then receive 1455 thereason for wasting. The central computer server system may then transmit1460 an additional question or questions, and subsequently receive 1465the answers to those questions.

Finally, a confirmation may be transmitted 1470 fern the centralcomputer server system to the remote device confirming the wasting. Theconfirmation may display in the form of a window, such as window 1000 inFIG. 10. The user may then proceed or cancel. If the user proceeds, thecentral computer server system receives 1475 confirmation of thewasting. Updated patient information may then be transmitted 1480 to theremote device.

FIG. 15 illustrates an embodiment of a method 1400 of retuning an itemor a portion of an item previously removed from a dispensing device, orotherwise issued or checked out to a user. First, the user may berequired to log in. This may require transmitting from a remote deviceto the central computer server system the user name 1505 and/or password1510 of the user. Alternatively or additionally, biometric informationmay be used to confirm the identity of the user. Once the user name andpassword are received by the central computer server system, the user'spermission to access the central computer server system, dispensingdevices, or dispensing devices in the user's vicinity is verified. Onceit is confirmed that the user has the right to access the centralcomputer server system, menu options are transmitted 1513 to the remoteterminal. Alternatively, the user's identity may b verified at theremote terminal, with no transmissions to the central computer serversystem.

The central computer server system may then receive 1514 a selectionfrom a menu. The selection made by the user at the remote terminal mayinclude specifying that an item is to be wasted. The central computerserver system may transmit patient information 1515 to the remotedevice. This patient information may include a listing of items removedfrom a dispensing device for use with the patient, the dosing of theitem, the patients name, and the patient's room number. The patientinformation may include all patients associated with the user or mayonly be patients associated with an item that requires wasting. Thecentral computer server system may transmit 1520 a listing of items thatare required to be returned or require that a portion of the item bereturned.

The central computer server system may then receive 1525 informationrelated to the return. This may include a quantity of an item to bereturned. Based upon the information relating to the return, the centralserver computer system may determine 1527 whether the quantity issufficient to be returned to a dispensing device. If not, the processmay be halted, or the user may be instructed to waste the remainder ofthe item. In response to receiving this information on wasting, thecentral computer server system may transmit a witness requirement 1530.This witness requirement may be similar to witness window 800 of FIG. 8,or may require different witness information. In response, the centralcomputer server system may receive information, including the witness'user name 1535 and password 1540 from a witness at the remote terminal.The central computer server system may then confirm 1545 that thewitness is a different person than the user.

In some embodiments, the central computer server system may transmit1550 a request for a reason for returning the item may be requested fromthe user or witness. The request for a reason for wasting the item maybe in the form of a window, such as window 900 in FIG. 9, or in someother form. The central computer server system may then receive 1555 thereason for return. The central computer server system may then transmit1500 an additional question or questions, and subsequently receive 1565the answers to those questions.

A pending status may be transmitted 1570 from the central computerserver system to the remote device confirming the return. The return mayremain in a pending state until the return is received at a dispensingdevice. Transmitting 1570 a pending status may also include transmittinga message to a dispensing device or multiple dispensing devices that theuser will be returning a item or a portion of an item. The centralcomputer server system may then receive login information from adispensing device. This may be to confirm the user's identity, or toassociate a pending return stored at the central computer server systemwith the user. In some embodiments, verification of the user at thedispensing device, with no transmission to the central computer serversystem. Additional information may then be required to be entered at thedispensing device. The user may then return the item to the dispensingdevice. Once the item or portion of the item is received at a dispensingdevice, the central server computer system may receive 1575 aconfirmation from the dispensing device. Updated patient information maythen be transmitted 1580 to the remote device.

It should be noted that the methods, systems, and devices discussedabove are intended merely to be examples. It must be stressed thatvarious embodiments may omit, substitute, or add various procedures orcomponents as appropriate. For instance, it should be appreciated that,in alternative embodiments, the methods may be performed in an orderdifferent from that described, and that various steps may be added,omitted, or combined. Also, features described with respect to certainembodiments may be combined in various other embodiments. Differentaspects and elements of the embodiments may be combined in a similarmanner. Also, it should be emphasized that technology evolves and, thus,many of the elements are examples and should not be interpreted to limitthe scope of the invention.

Specific details are given in the description to provide a thoroughunderstanding of the embodiments. However, it will be understood by oneof ordinary skill in the art that the embodiments may be practicedwithout these specific details. For example, well-known circuits,processes, structures, and techniques have been shown withoutunnecessary detail in order to avoid obscuring the embodiments.

Also, it is noted that the embodiments may be described as a processwhich is depicted as a flow diagram or block diagram. Although each maydescribe the operations as a sequential process, many of the operationscan be performed in parallel or concurrently. In addition, the order ofthe operations may be rearranged. A process may have additional stepsnot included in the figure.

Moreover, as disclosed herein, the term “data stores”, “central servercomputer system” and “administrative records computer server system” mayrepresent one or more devices for storing data, including read-onlymemory (ROM), random access memory (RAM), magnetic RAM, core memory,magnetic disk storage mediums, optical storage mediums, flash, memorydevices, or other computer-readable mediums for storing information. Theterm “computer-readable medium” includes, but is not limited to,portable or fixed storage devices, optical storage devices, wirelesschannels, a sim card, other smart cards, and various other mediumscapable of storing, containing, or carrying instructions or data.

Furthermore, embodiments may be implemented by hardware, software,firmware, middleware, microcode, hardware description languages, or anycombination thereof. When implemented in software, firmware, middleware,or microcode, the program code or code segments to perform the necessarytasks may be stored in a computer-readable medium such as a storagemedium. Processors may perform the necessary tasks.

1. (canceled)
 2. A method for managing items dispensed from a dispensingdevice, the method comprising; receiving, by a computer system from aremote computer system, login information from a user; verifying, by thecomputer system, the login information from the user; after verifyingthe logic information from the user, transmitting, by the computersystem to the remote computer system, indications of multiple itemsdispensed from the dispensing device for multiple patients associatedwith the user that are required to be wasted; and receiving, by thecomputer system from the remote device computer system, information fromthe user about wasting at least a portion of an item of the multipleitems removed from the dispensing device that are required to be wasted,wherein: wasting at least the portion of the item comprises physicallydestroying or discarding the portion of the item.
 3. The method formanaging items dispensed from the dispensing device of claim 2, themethod further comprising: presenting, by the remote computer system, aninterface that indicates the multiple items removed from the dispensingdevice for multiple patients associated with the user that are requiredto be wasted.
 4. The method for managing items dispensed from thedispensing device of claim 2, the method further comprising:transmitting, by the computer system to the remote computer system, arequest for an indication of an identity of a witness to the wasting ofthe at least the portion of the item.
 5. The method for managing itemsdispensed from the dispensing device of claim 2, the method furthercomprising: transmitting, by the computer system to the remote computersystem, a request for a reason for the wasting of the at least theportion of the item.
 6. The method for managing items dispensed from thedispensing device of claim 2, wherein transmitting indications ofmultiple items removed from the dispensing device for multiple patientsassociated with the user that are required to be wasted comprisestransmitting indications of amounts of the multiple items that areexpected to be wasted.
 7. The method for managing items dispensed fromthe dispensing device of claim 2, further comprising: receiving, by thecomputer system, a request for an item from the user; receiving, by thecomputer system, an authorization override from the user; and inresponse to the authorization override, authorizing dispensing, of theitem by the dispensing device to the user.
 8. The method for managingitems dispensed from the dispensing device of claim 7, furthercomprising; after dispensing the item by the dispensing device to theuser, receiving, by the computer system from the remote computer system,information about an emergency situation related to the authorizationoverride.
 9. The method for managing items dispensed from the dispensingdevice of claim 2, further comprising: dispensing, by the dispensingdevice, the multiple items to the user prior to the computer systemtransmitting the indications of the multiple items dispensed from thedispensing device for the multiple patients associated with the userthat are required to be wasted.
 10. The method for managing itemsdispensed from the dispensing device of claim 2, wherein the multipleitems are controlled medical substances.
 11. A system for managingitems, the system comprising: a dispensing device configured to dispensea plurality of items to multiple users; a remote computer systemconfigured to communicate with the host computer system via a network;and a host computer system configured to: receive, from a remotecomputer system, login information from a user; verify the logininformation from the user; after verifying the logic information fromthe user, transmit, to a remote computer system, indications of multipleitems dispensed from the dispensing device for multiple patientsassociated with the user that are required to be wasted; and receive,from the remote computer system, information from the user about wastingat least a portion of an item of the multiple items removed from thedispensing device that are required to be wasted, wherein: wasting atleast the portion of the item comprises physically destroying ordiscarding the portion of the item.
 12. The system for managing items ofclaim 11, wherein the remote computer system is further configured to:present an interface that indicates the multiple items removed from thedispensing device for multiple patients associated with the user thatare required to be wasted.
 13. The system for managing items of claim11, wherein the host computer system is further configured to: transmit,to the remote computer system, a request for an indication of anidentity of a witness to the wasting of the at least the portion of theitem.
 14. The system for managing items of claim 11, wherein the hostcomputer system is further configured to: transmit, to the remotecomputer system, a request for a reason for the wasting of the at leastthe portion of the item.
 15. The system for managing items of claim 11,wherein the host computer system is further configured to transmitindications of amounts of the multiple items that are expected to bewasted.
 16. The system for managing items of claim 11, wherein the hostcomputer system is further configured to: receive a request for an itemfrom the user; receive an authorization override from the user; inresponse to the authorization override, authorize dispensing of the itemby the dispensing device to the user; and wherein the dispensing deviceis further configured to: dispense the item to the user in response tothe host computer system authorizing dispensing of the item.
 17. Thesystem for managing items of claim 16, wherein the host computer systemis further configured to: receive, from the remote computer system,information about an emergency situation related to the authorizationoverride after the dispensing device dispensed the item to the user. 18.The system for managing items of claim 11, wherein the dispensing deviceis further configured to: dispense the multiple items to the user priorto the host computer system transmitting the indications of the multipleitems dispensed from the dispensing device for the multiple patientsassociated with the user that are required to be wasted.
 19. The systemfor managing items of claim 11, wherein the multiple items arecontrolled medical substances.
 20. A computer program product residingon a non-transitory processor-readable medium for managing itemsdispensed from a dispensing device, the computer program productcomprising processor-readable instructions configured to cause aprocessor to: receive login information from a user; verify the logininformation from the user; after verifying the logic information fromthe user, cause indications of multiple items dispensed from thedispensing device for multiple patients associated with the user thatare required to be wasted to be transmitted to a remote computer system;and receive information from the user about wasting at least a portionof an item of the multiple items removed from the dispensing device thatare required to be wasted from the remote computer system, wherein:wasting at least the portion of the item comprises physically destroyingor discarding the portion of the item.
 21. The computer program productfor managing items dispensed from a dispensing device of claim 20,wherein the instructions are further configured to cause the processorto: receive a request for an item from the user; receive anauthorization override from the user; and in response to theauthorization override, authorize dispensing of the item by thedispensing device to the user.